Book Reviews

History of American City Government. The Colonial Period. By ERNEST S. GRIFFITH. (New York: Oxford University Press, 1938. 464 p. $3.75.) Recently observers have been noting a new approach in the writing of local history. For a long time most writers on American towns and cities, while abundantly endowed with filial piety and with a fund of genealogical and antiquarian lore, were only poorly equipped with broad historical background and understanding of the significance of their communities in the development of the nation as a whole. But for the last few years historians and social scientists have been coming to see that individual towns ought not to be treated in isolation, as if they were of interest only to their present inhabitants and to descendants of earlier settlers. One important avenue to an understanding of the broad course of American life is now seen to be the history and institutions of local communities, considered both as products of our civilization and as contributing factors to its development. Dean Griffith has added to this newer approach a welcome volume, the first of a series of four which he has planned on the political institutions of the American city from the first settlements to the present. For the most part the book is organized topically rather than chronologically. It begins with a consideration of the English borough as a background and precedent for municipal organization in the colonies. It then examines colonial charters of incorporation, analyzing the sources of authority, the reasons for incorporation, the powers conferred, and the structure of local governments. An important chapter on the municipal control of economic life is followed by sections dealing with such matters as the actual functioning of borough and city government, finance, the extent of popular participation, and the relations of the municipalities to the colonial governments. The author gives his estimate of the quality of government provided in the towns and concludes his text with a "Survey of Trends and Changes." Appendices list, with considerable bibliographical data, the actual incorporations of municipalities before the American Revolution. From the outset there is some confusion as to terms. The author is really dealing with municipal rather than with city government. Cities, in whatever way they may be defined, are only a few of the places with which he is concerned. At the same time, he is unwilling to include all urban areas or organized local governments. And he finds, very understandably, some difficulty in deciding which communities ought to be included and which excluded. Some places are discussed in certain connections but ignored in others. Among the author's criteria of selection (none of them invariably applied), the most important is the issuance of a formal document, a charter of incorporation. As a result, the most characteristically American type of local government, the New England

Part 1. 8vo. pp. 247. 1810. Maxwell. Tiie Society lias changed the title of its volume, as well as the mode of publishing it. Transactions is certainly a more appropriate term for such a work than Memoirs, and by being favoured with it in parts, at shorter intervals, our curiosity is gratified without our patience being exhausted.
The volume commences auspiciously, with a paper from Mr. Mason Good, on Medical Technology. After eloquently descanting on the imperfection of our language, and the consequent confusion of olir ideas, Mr. Good refers the I sources of the corruption to the following heads : " First, the intermixture of different tongues that have no family or Memoirs of the Medical Society of London. 57 or dialectic union. Secondly, the want of a common principle in the origin or appropriation of terms. Thirdly, the introduction of a variety of useless synonyms, or the adoption of different words by different writers to express thesiune idea. Fourthly, imprecision in the use of the same terms.
Fifthly, an unnecessary coinage of new terras upon a coinage of new systems.1' P. 4.?He then makes some remarks upon each of these sources, and concludes " with a few hints for such a general correction and improvement of medical language as may yet be introduced into it without violence or ostentation."?Mr. Good has been very successful in detecting errors and imperfections ; he has handled his flail dexterously, and the chaff has flown in all directions. If he has not been equally fortunate in suggesting remedies for all the evils which lie has detected, it is, we apprehend, rather from the difficulty of the subject, than from any lack, of ingenuity on his part. We quote the following specimen of his powers in the exposition of erroneous terms, almost at random. " What is the meaning of tone ? In therapeutics, in physiology, and in the common language of mankind, sound and healthful elasticity : that voluntary reaction or state of extension between antagonist muscles, as Galen has admirably observed after Hippocrates, by which they are removed from a modification of rest; and in which the one yields to the other, not from utter debility, but in a precise ratio to the superiority of power exercised over it * Whence that class of medicines which contribute to this elasticity or healthful reaction in irritable or weakened organs is denominated tonics ; while organs which are destitute of it are said to be in a state of atony. But if tone be used to imply health, and tonics restoratives of health, what are we to understand by the phrase tonic sfiasm ? a phrase founded upon an erroneous physiology, perpetually, as I fear, leading us astray in our practice, and applied to a state of muscle in which there is no more tone, elasticity, or healthful reaction, than in the frozen strings of a violin. To shew the full force of the absurdity of this phrase, it is only necessary to translate it; and to tell the English reader that it means neither more nor less than extensible contraction.
Phrenitis is a common and very proper term for phrensy or inflammation of tlie brain ; but paraphrenias is employed to express inflammation of the diaphragm. How is this last sense to be explained ? The medical lexicographers tell us that the preposition ?na.fx is here used as a diminutive to denote a kind of sympathetic phrensy. Yet nothing cart be more superficial ; and here, as in the former case, the term is derived from an erroneous physiology. Phren (<pfw) in paraphrenias, has a reference to the very vulgar but very early opinion of the residence of the soul in the pra:cordia ; while para, instead of diminution or defect, implies proximity?inflammation around the seat of the soul. Yet the meaning of nx^x is about equally divided between the ideas of proximity and defect in the medical use of the term, and hence the student ? DeMotMuscul. lib. ii. can derive no precise information from its employment. Thus the par acme of a fever means its decline; paracusis depraved hearing; fiarancea defective judgment; in all which vxpx is used diminutively: while in parotis, parathenar, paronychia, it implies proximity alone. In paralysis its intention h doubtful, for it may be taken either way. There are many other prepositions and particles which, in composition, are used in the same indeterminate manner, and considerably augment the confusion of our vocabulary." P. 30.
Haying' happily pointed out the " extraordinary intertexiurc, the liiscqrMia coticors" of the medical language of the day, Mr. Good proceeds to offer his assistance in correcting it. He advises us " to discard.all equivocal terms as much as possible ; and in cases where this cannot be done, to assign a fixt (fixed) and individual sense to every term, and never o employ it in any other sense." He recommends us to create as few nevv words as possible; and among those already in use, to confine ourselves to the same term to express the same idea, even where we have a choice of numer >us. synonyms. He wishes us " to limit our nomenclature as much as possible to one language alone and prefers the Greek, because " by far the greater part of our technology is already derived from it, and that it possesses a facility of combination to which the Latin has no pretensions." We are then, " to banish every Latin, as well as well as every Arabic, Spanish, Italian, and German word in favour of its Greek synonym." But as many diseases, such as syphilis, smallpox, See. were unknown to the Greeks, we must condescend to explore the writings of more modern authors to enrich our vocabulary.?Mr. Good concludes with submitting the following regulations : " 1 Let the particle a (a) express alone the idea of total privation ; as in amentia, agalactia, amenorrhea. " 2. Let dys (ovs) express alone the idea of deficiency, as its origin ctw or c^/xj most naturally imports, and as we find it employed to express in dys-pnoaa, dys-cinesia, and dysphagia. " 3. As an opposite to dys, let en (ev) be employed as an augmentive particle, as we have it in en-harmonic, en-telechia, and en-ergetic. En is not often, indeed, a medical compound, nor do [ recollect its being employed in more than two instances ; encefdialon, in which it has the sense of interior (a word, indeed, that has been long falling into disuse), and enuresis, in which it imports excess, and is consequently used as' now recommended. Thus restricted, ev and will have the force of virsp and xxrw, but will be far more manageable in the formation of compounds. " 4. Let agra (aypx) be restrained to express the idea of simple morbid affection in an organ, synonymously with the Latin passio, or the berh of the Arabians. " 5. Let itis (ths) express alone the idea of inflammatory action, a? in cephalitis, gait l itis, nephritis. ? 6. Let Memoirs of the Medical Society of London. 59 " 6. Let algia (xXyix) express alone the idea of pain 01' ache, to the banishment of such useless synonyms as odtjn? and cofios or co/ius. " 7. Let rhagla (from fium*) .rurnfio') be confined to t;Hpress a'preternatural flux of blood. !? ' " S. Let rhaa (from psuJIuo) express a prceteinatural flux of any other kind." A table of radical compounds is subjoined.
We give the author credit for the learning and the ingenuity which lie has displayed in this essay,, but we have no apprehension of being obliged by his verbal speculations, (o disburthen our memory of the " gibberish" acquired from ancient writers, and charge it with new terms, which have not always the merit of being more appropriate, and in many instances, are more barbarous and cacophonous. Thus v>e have enenteria for diarrlnea ; gastrorrhagia for luematemcsis; pneumonorrhagia lor hajmoptoe; iirirrh agia for I Hematuria ; urirrhcea for pyuria ; .ophthalmalgia for aehe of the eye-ball.
We know that Mr. Good, is verv conversant with dictionaries, and were therefore surprised at his remarks on the particle e/?, which is used as a compound much more frequently than he seems to be aware of, as in enaeorema, enarthrosis, cncanthis, enccelia, encauma, endemic, en cope, &c. &c.
AV ithout any pretensions to the art of prophesying, we may venture to predict, that whilst the wo^ks of Hippocrates, of Sauvages, of Cullen, and of numerous other accurate describes of diseases, continue to be read and admired, the terminology which they have used will be adopted. The reform of language is slow and gradual ; and till we have belter books, and more complete systems of medicine, we must endure the jargon which prevailed in the times when our best treatises were Composed ; hit us bear in mind the opinion of Vaugelas, il Lorsqu'une fagou de parlor est usitee des bons auteurs, il nefaut p is s'amuser a en faire Pauaiomie, ilia pointiller dessus, conune font une infinitede gens ; mats il faut se laisser em porter au torrent, et parler comnie les autres, sans daigner econterces eplucheurs de phrases." In the second article, the President, Dr autumn of the following year, the lecturing con Hcction between liim and Mf. Hunter being dissolved, lie commenced on his own account, and opened his course with a lecture on the uses of the spleen and thymus. In 1774, he published his work on the lymphatic system, and in the spring of the same year, whilst blessed with domestic felicity, and favoured by extensive practice,and well earned celebrity," he was attacked with a fever, occasioned by a wound which he received in dissecting a morbid bodyand died on the 1st of May, at-the age of 35.
Mr. flewson's celebrity chiefly hinged on his discovery of the lymphatic system in birds and amphibious animals, and his experiments on the blood. Dr. Monro has disputed (we believe unjustly) his claim to the fir t, and modern chemistry has, in a great degree, destroyed the value of the latter. Wo must admire his ingenuity -ind his industry, and lament that the fame of man rests on frail materials.
The third article in the Transactions, contains a "History , of fatal effects from the accidental use of white lead by John Deering, Surgeon, with additional remarks, by William Shearman, M. D. We shall state the substance of the case as related by Mr. D. Mrs. R October 21, 1808, *' complained of violent pain in the ?crobiculus cordis, with great soreness of the epigastric region when pressed upon. She had vomited a considerable quantity of bilious matter, and at the same time her bowels were constipated: the pulse was calm and regular, the tongue clean and moist, and there was no symptom of fever present. She immediately took a cathartic, which operated, and an opiate in the evening." In the morning she was relieved ; but in the evening the pains and vomiting returned, and continued for some days very distressing.
Nov. 4. A physician was called in; he considered the affection as rheumatic and spasmodic, and discontinued his visits in a few days, in consequence of the-amendment of the patient. " In about a week after this period, a boy in the same family, nearly sixteen year3 of age, was seized with symptoms exactly similar to thpse of the preceding case, and similar remedies afforded only partial relief, till at length he was removed into the country, and thereby recovered his health." Another child, soon afterwards, was seized with similar symptoms, the mother relapsed into her former state, and three otMer persons in the family laboured under analogous affections. Poison was now suspected, but no indication of it, after minute investigation, appeared. The child, in about a fortnight, was pronounced by his physicians in a convalescent state; but was soon after seized with convulsions, and expired within 3 few hours. Mrs. R. in whom the sickness and pain had continued unabated, now gradually grew a litde better " She had hitherto continued to suckle her ch:ld, which, it being fifteen months old, she was advised to wean: to this jhe reluctantly consented. In about ten days afterwards the child bjcarae somewhat costive, without any other apparent indis-Memoirs of the Medicctl Society o f London. 61 indisposition; but at this period it was seized with vomiting and convulsions, and suddenly expired." The unfortunate mother, after experiencing some relief, without being entirely free from complaint, on the 2lst of January, 1809, was -eize^ in the morning with convulsions, which continued till 5 o'clock, P. M. when she expired. On the .ib* sequent day, Mr. Chevalier examined the body by dissection ; he could not, however, discover the least trace of morbid affection.
Of the three other persons who were indisposed, two recovered, and one died after lingering under disease till March.
A Committee of the Medical Society proceeded to inquire into this extraordinary case; but no probable cause for the calamity was ascertained, till Dr. Laird detected a white powder adhering to the inner surface of a cask which had contained sugar used by the family. Upon subjecting this powder to heat by means of the blow-pipe, globules of lead in the metallic state were produced. The mystery was now developed. The sugar had been put into a cask ^jhich had previously contained white lead, and becoming impregnated with the metal, was, doubtless the source of the fatal events described " Of nine persons in this family, who were more or les= indisposed, four died, and the effects of the poison appear to have been nearly in the ratio of their respective ages." _ Dr. Shearman describes an affection of the bowels very similar to the above, which prevailed in a provincial town. 'J lie canse of the complaint was traced by Dr. S. to some Holland's geneva, which he found contained a metallic poison.
The spirit had been bought, at the Excise office, and the chief officer, on being examined before a magistrate, " confessed thai the whole of the quantity of Holland's sold at the last sale had been impregnated with sugar of lead, for the purpose of depriving the spirit of the colour which it always contained by being kept some time in the tubs in which it was brought over sea by the smugglers." Dr. Dixon, of Whitehaven, in the fourth article, relates the history of a case resembling hydrophobia, from the bite of a cat. The animal was not supposed to be mad, but the symptoms of the patient were unquestionably those of a person affected with rabies canina, and terminated in the usual fatal manner. Our limits will not admit of the whole of this interesting case being inserted, and its value would suffer from being abridged or partially detailed. The fifth article, by Dr. Falconer, of Bath, treats of the " indiscriminate use of mercurial preparations." The author commences with some well expressed animadversions on quackery, a subject indeed, on which little can now be said which has not been advanced by a hundred writers before ; of this part of his essay we quote the following with approbation : " The absurdity of implicit faith in the decision of beings of our own nature and rank in the line of creation, is not confined to religion. Medicine ? dicine affords numerous instances equally striking, and both perhaps produced by nearly :he same cause. The miracles of the Romish church, and the instances of cure produced by empirics, bear a strong resemblance to each other ; and the practitioners of medicine in this branch have not much fallen short of their religious associates in the extraordinary instances of success which they exhibit." Pag. 99. Alter stating (he usual effects of mercury on the system, the learned author proceeds with his inquiry into the operation of calomel in some of the disorders in which it is prescribed. He thinks it is prejudicial in scrofula, and in glandular swellings, being more likely from its " stimulant and inflammatory qualities" to lay the foundation of obstruction than to remove it. " A state of indisposition, marked by a pale leaden-coloured countenance, defect of app^ite, paucity of urine, and sense of weight rather than of pain in the abdomen, accompanied with low spirits; a pulse sometimes rather slower than ordinary, but generally irregular in this respect; and often a dry but harsh or corrugated skin, and a degree of animal heat, rather below than above the natural standard; frequently occurs among those who resort to the Bath waters for relief. " Complaints (he observes) of an obscure nature are denominated bilious, on a strange and even contradictory supposition that they proceed h orn either a deficiency or redundancy of bile, or from its depraved or corrupted state; though no marks of any of these faults appear, either in the colour of the skin, or the colour, quantity, or rather qualities of the evacuations. It would have been fortynate for mankind, if the practitioners of medicine had done in the present age as Dr.
Swift satirically describes them to have done in his time, and, for the cure of these imaginary diseases, to have invented imaginary remedies. But, unfortunately, giants have been brought on the" stage to combat pigmies, or rathei shadows. Every dabbler in medicine prescribes calomel as freely, and on the most trifling occasions, as he would th? most insignificant article in his shop ; and this active, and in many instances dangerous, article is smployed oftener, I believe, to the destruction than to the preservation of mankind." We might quote two pages more on the deleterious effects of this powerful mineral, but we believe they would be familiar to most of our readers.
Dr. Falconer has unburdened his conscience in relating them, and we have pleasure in assuring him, that we read of many more shocking cases, than we have ever experienced in a very free and extensive use of the remedy, or have observed in the practice of two of the largest hospitals in Britain : Dr. Falconer has himself witnessed some of the evils which he describes, and we cannot doubt his testimony ; but it seems to us almost inconceivable, that any intelligent practitioner in the present day can push a remedy beyond due bounds, or persevere in its use, when the direful consequences are manifest. We commend his concluding caution, though we think the practitioner who stands in need of it must, be very young. " I cannot quit this subject without remonstrating in the strongest manner against the too frequent practice of administering on common occasions calomel to young children. It has been found, when largely given, to weaken, and even to disorder, the mental as well as coipoieal faculties of grown persons, and the use of it at an early age, when the faculties of either body or mind have not acquired strength and firmness, may both impair the bodily health and debilitate the mental energy of persons, who might, but for such imprudent interference, have distinguished themselves when further advanced in life." F To be continued. J The author has divided this little work into four, or rati er into five chapters, for there are two chapters I\r. The first treats " of the climate and voyage." Malta lies in 35?.
of north latitude; the climate is mild and dry, and the atmosphete clear*. The thermometer throughout the year is very regular arid not subject to sudden changes. In summer it ranges from 70? to S8?; and in winter from 57 to CO0.
Dr. Domeier thinks that u this equality must be a great advantage for the recovery and the prevention of those numerous diseases, which are brought on, and maintained by suppression of the cutaneous perspiration, viz. chronic dysentery, diarrhoea, rheumatism, gout, coughs, catarrhs, ophth almia, cholic, dropsy, cutaneous eruptions, &c." 44 During three or four months in the summer, it does not rain at ali, and rarely even in the winter." " Showers of hail fall once or twice in the winter, but snow never." The dews and fogs arc inconsiderable. In September the sirocco (south-east wind> prevails, and renders the air dense and damp. " Persons with flat narrow chests, or those who have diseases in their lungs, such as schirri, vomica?, ulcers, ?water in the breast, &c. feel uneasy on the days when the wind blows." The island is free from endemic diseases, and the only epidemic which Dr. Domeier observed during three years residence, was the small-pox, which, however, was much checked by a general inoculation of the cow-pox.
We are informed that a packet leaves Falmouth every three weeks, and arrives at Malta in about a month. The best time for sailing is the middle of August. Consumptive, dropsical, and rheumatic patients, often experience much benefit from the voyage.?The next chapter contains an account " Of Medical Assistance and Diet," from which we learn, that the latter is much superior to the former. Provisions of all kinds are excellent, cheap and plentiful, whereas the physicians, except three, are stated to be " without knowledge and judgment," and of the three the best is merely- From the two preceding Chapters we learn, that amusement and social pleasures are enjoyed in as great perfection in Malta as at any of our fashionable watering-places in this country, but great temperance and moderation arc preserved by all ranks of people in the island. The botanical garden instituted by the late governor Sir A. Ball, affords the inhabitants of 44 all ages, sexes, and classes," a convenient and pleasant promenade, where 44 devout monks walk near dashing officers; young, blooming girls wishing to attract noticenear decrepid men, who feel no attachment for their neighbour, of for this life altogether; nurses paying more attention to the society than to the infants trusted to their arms ; English ladies, tastefully dressed, next Maltese ones, covered with the saldarra* ; and to fashionables it is Bondstreet." Of course, among this motley groupe we hear of no students. " In the last Chapter we are informed that there arc some tolerably good schools in Malta, and a university at Valetta.* Of this we are sorry to remark, the medical faculty is extremely defective; perhaps on this account, the inhabitants are prohibited from resorting to the universities of Italy for obtaining instruction, which they cannot receive at home. Amongst the defects in the medical department may be enumerated the appointment of only one lecturer, who is expected to tcach all the branches of the healing art in two hours each day. Natural history and experimental philosophy are not taught there; no anatomical theatre/and itf>, clinical lectures are delivered.
The Maltese hospital is attended by four physicians, and four surgeons. These " change every month in performing their duty, so that a patient, who comes in the last day of the month, falls the first of the next immediately under the hands of another practitioner."-And " in most cases the whole plan of cure is altered." The medical officers " It is Certain that facts have arisenfully proving tlieefficacy of the Datura Stramonium in quieting the paroxysm of asthma.
In some cases, however, of this disease, it lias been inert; in others, it has been injurious. It remains to be pointed out in which it is serviceable, in which inert, and in which injurious.
si vel levissime sint imbecilles, quamvis nullam morbi notam prjc se ferant, agre patiuntur ventum, icrnem, pulverem, aut lectionem. Cornm:nt. de morb'ts ocular um.) A strong glare of light is always painfullydistressing to the patient ; and hence, in aggravated cases of this disease, the effulgence of the Sun's rays when admitted to the Eye, excites in it a very acute sensation, which is accurately referred to the bottom of the orbit; around which there is at the same time, a sense of tension and oppressive uneasiness.' For the same reason, the patient is miserably uncomfortable in a brilliantly illuminated apartment. Inordef therefore to. exclude the strong and direct ray . of light, he instinctively depresses his eyebrows, or applies his hand to hi-> forehead, viewing objects with the palpebras halt closed, by which lie is apt to acquire the habit of *blinking. If. he attempt to read, or look at -mall o'r bright objects, he is soon dazzk'd, and his vision becomes confused, which ridded to the pain the effort occasions, speedily compels him to desist. The iris acts with great energy on the admission of the rays of light to the retina, and in consequence, the pupil becomes contracted to a very small aperture ; a striking feature of this disease. When the stimulus of light affects the Eye, there is sometimes, though very rarely, a manifestly deficient action of the lachrymal glands, but much uftener the secretion of tears is abundantly copious,f which is indeed the principal, cause of the confused vision occasionally attending this malady.
2d. Remote or predisposing Cause. u General debility, however, induced, though not essential, seema ?greatly to predispose to this complaint. Hence, its most frequent occurrence to persons recovering from previou-illness, and to those of a relaxed habit. Females are most obnoxious to its attacks, as the predisponent causes are most liable to arise in the low tone of their system. " Most of the instances of weakness of sight, occur under great constitutional delicacy. ' /'' ' ?" v ? 3d. Exciting Cause.
" Long or frequent exposure of the eye to a very vivid or reflected light, or its excessive exertion in reading,' or viewing minute and dazzling objects. 4 th. Proximate Cause.
'j The proximate cause of weakness of sight, instead of being a local debility, consists in an exquisite irritability and sensibility of the ? I am assured bv nn intelligent and learned traveller, that the inhabitants ?who reside at the font of the Glaciers in Switzerland, acquire tbis hahit in a 'remarkable degree, in consequence probably of the vivid light that is rcflecte d from the accumulated fields of ice and snow, to which they are perpetually exposed. f -f-Many people amongst the ^Ethiopians, Africans, &c. who have an extreme degree of tenderness of si^ht, owing to the great brilliancy of thp Sun's rays, suffer exceedingly, according to Haller, (Tom. v. p. 490.) frdm violent epiphora, or watery e\e, which in fact renders them nearly blind during the ?iay. " ?
'? ,> -jetina* Stevenson on a Disease t)f i he T^t/e. r,etina, the effect of great turge.scen.qy of the vessels, or a chronic inftaramation of that membrane, or the choroid." 5th, The Cure.
The remote causes of this disease, or what have been understood to be its remote causes ; as well as an obvious reasoning upon its exciting causes, led to an erroneous conclusion, and to a fundamental mistake in the treatment.
A morbid sensibility of the retina, tin; effect ol exhausted nervous energy, was deemed to constitute the very essence of this complaint. On this hypothesis, the symptoms were combated by the external application of sedative and tonic, and by the internal exhibition of corroborant and nervous remedies.
The corn pleat failure of this method led Mr. Stevenson to adopt an antiphlogistic and evacuating plan. His observations brought him to conclude, " That the exquisite s en sibility of the Eye might with more probability result from a chronic inflammation, or at least a highly turged condition of the blood-vessels of the retina or choroid." " Agreeably to this supposition, 'the indications of cure must consist, not in giving additional tone by the use of cold astringent applications, and internal strengthening medicines, but in lessening the plethoric state of the vessels of the posterior membranes of the eye, and in obviating, at the same time, the exquisite sensibility of the retina." On this principle, leeches were applied* to, generally, the * " The application of leeches so immediately in the vicinity of the eye, has been pointedly reprobated by a celebrated author on ocular complaints, because, says he, they have sometimes been found to occasion n considerable swelling of the lids, and have also, for a time, increased, instead of lessened the irritation of the eye. In order to prevent which mischief, he adds, it will be proper to apply the leeches to the hollow of the temple, in a very large number of cases in which I have known them applied to the lower eye-tid, under the direction of the late Mr. Saunders, as weil as under my own, I have indeed very rarely witnessed the effects above alluded to ; and where any inconvenience of the kind has occurred^ it has been in highly irritable habits greatly disposed to crisypelas, in which cases the same consequences are apt to supervene even from tlie application of a blister. But I am convinced, from the fullest observation and experience, that the benefit they afford the patient nv/ten placed as near as possible to the inflamed eye, infinitely exceeds what the same number are capable of yielding, by being laid on the temples, and more than compensates for the greater degree of ecchymosis, which 1 admit is more prone to take place by the" extravasation of blood into their loose reticular texture, than into the denser cellular membrane of the temples, and which tempcrary inconvenience constitutes 70 Critical Analysis; tinder eye-lid ; cathartics Ave re employed, and managed in a way which Mr. Stevenson explicitly describes:+ Fomeutathe principal, if not the only real objection against their application to the lower eye-lid." Having ourselves observed the inconvenience here stated, and also a troublesome ulceration when leeches have fixed on the upper eye-lid, v/e are gratified in stating the opinion of a gentleman of much practical knowledge, on a point often important in private practice, in more than one view. When an ecchymosis does take place, Mr. Stevenson recommends aq. ammon. reduced with water, or the juice of Solomon'e itaU for removing it. We have often had an opportunity of observing the advantages that arise from attending to eu/inrisiic medicines.
The Solomon's seal (Conn all aria multlflora Linn.). afFoids an instance of an indigenous plant that deserves investigation. It is so common as to be found in the woods of many, if not all the English counties ; is perennial, flowers in May and June; and has been long known, as a popular remedy for removing ecchymosis very speedily. The professors and pupils of the pugilistic schools are well acquainted with this iact. It may be worthy of enquiry whether the reputed effect of Con-?oaUarta multiflora in hernia, has any actual foundation. Applied to the protruded part, and given internally in powder and infusion, it was once thought to be useful. If mixed with its congenors the Conuallari'a maxalis, C. vcrticillata, and C. Jiolygonatum, would its properties be improved ? f " Purgative medicines as exhibited by practitioners in general, for the acutc inflammation of the eye, whether external or internal, have been given,ntuch too sparingly, both in regard to their dose, and to tlie times of their repetition. If they be meant to produce any decidcdly good effect, they must at first be administered in a full dose, so as to excite an immediately copious evacuation, and repeated afterward in such a way as to keep up a conssant determination to the bowels. Should the patient be of a robust habit of body, nothing is so effectual for that purpose as a full dose of calomel with antimonial powder, and in two hours afterward, a sufficient proportion of powdered jnlap, and double the quantity of cream of tartar in mint water, or gruel; by the operation of which, a large discharge of serous fluids is solicited, and the vigor and activity of the general circulation sensibly diminished. In more delicate constitutions the calomel must be given sparingly, and in Sieu of the jalap, an adequate quantity of magnesia viiriolata in infusion of senna." " 1 have repeatedly observed, Mr. Stevenson adds, that gentle apperients in these cases make no impression upon the disease'; but, if the operation of the remedy be powerful, the most manifest advantage is certainly obtained. In the management of this class of remedies, it is customary to allow two or three days to intervene before they are again repeated, by which time the effects of the first dose have wholly subsided, and little comparative advantage is gained. On this account the cathartic should be employed in a full dope, and as frequently as the patient can bear. / Slcienson on a Disease of the Eye.
-Jl lised warm, anil composed of narcotic substances? in an aqueous decoction*. These were applied morning and eveu-'bear. The object is not only to lessen the actual quantity of circulating fluids, but also to prevent their immediate accumulation, and the consequent distention of the vessels upon which the inflammation depends. This purpose should be effected by the observance, at the same time, of a strictly antiphlogistic regimen, allowing only a small quantity of diluting liquids, and by interposing between the active purgation, small quantities of emetic tartar, combined with some mild saline aperient, repeated so as to keep up a constantly moderate diarrhoea." In every species of acute ophthalmia, and in every kind of inflammation, or fullness of the vessels of the eye, Mr. Stevenson found this method effectual ; and often superseding the necessity of repeated topical bleedings. Ihis practical fact, so fully confirmed by Mr. Stevenson's experience, was undoubtedly known to Hirpocp..ATEs, who asserts, Aphorism 17> section 6. Lippttudinc laboranlcin alvi prnfluvio corrifu, bonum ; and succeeding practitioners have availed themselves of it. Celsus says, omnlque dejectio Tipfncndi prodest. (Lib. 4, cap. 8, page 77, 8vo Edit-13iponte, 1786,) and the annotators on Hippocrates subjoin, " Ratio est, quia jit revulsio a tupernis deorsum materia live humoris ojihthalmiam fatientis. Debet er^o Mcdicus naturam imitari, cum ilia morbum sanat-Cardan. fi. 622, Corf. Dure!. in Coac. p. 120. Enim vera optime caput ab humorum afflu::u liberant laxantia, veletiam pro circumstantiarum rations purgantia. Et Galenus gravis testis est, nonuullos, quibus oeuli injlammati, so/a purgatione per alvum una die sauatos. Hoffm. Med. Rat. T. 4, S. 1, p. 525. We believe, however, that the fact has never been so strongly put as-by Mr. Stevenson. * For the fetus Mr. Stevenson employed the capsule of the poppy* chamomile flowers, rosemary, and eyebright infused in hot water, but confesses he is unable to determine if. any of these substances augmented the efficacy of the water. Are we to suppose the Euphrasia officinal was employed because it was formerly in repute as a remedy for impaired vision, and even had the power to make old eyes again young. Tmitum esse, ait, Euphrasia in imbc\licai/c visus vim atque efficaciam, ut ejus ttsu septuagenari os quosdam, propter vigilias et studia plurima amiss? visu, in decrepita ista etate, cum recu/iarasse obscrvavrrit. ^ i hese air the tales of other times. We have more satisfaction in resting on the ?trong evidence of the effrcacy of the long neglected digitalis. I cannot omit to state, says Mr. Stevenson, (p. 77) that I have used a.warm decoction of digitalis (pufiurea), with the effect of diminishing, materially, the exquisite sensibility of the eye ; nor does its applicstion pioduce any uneasiness, like the different preparations of opium. In violent inflammations of the eye, the decoction of this plant has been used with marked success by Dr. Haworth;?in the most severe attacks ofN the Egyptian ophthalmia it has alleviated the suffering?and it has been extensively employed, in strong infusion, to the inflamed eyes of horses, with similar results. Saffron in the form of a warm infusion tends also.
Mr. Stevenson assures us, most powerfully to take oft the morbid sep-?ibility of the eye. 72 Critical Analysis.
ins;, as hot as could be comfortably borne ; anil after the eye* Mas dried from tlie fomentation^ a quantity of a Unclura opii rniiis * was dropped into it. But sometimes, in very confirmed cases,'it became requisite to apply a permanent blister to the head, below the ears, or between the shoulders.
'Under this management modified to the peculiarities of individual cases, the disease usually subsided in a very short period : and due perseverance, with the addition of tonics, when the congestion was removed, effected permanent cures.
There are diseases of the eye so nearly resembling this as to be mistaken by very able men. It is essential to clearly ascertain these, because the remedies proper for them will be useless in " ioeal:ness of sight," and vice versa.
" By the disease termed by Hippocrates, amblyosmos: by Aret?cus, amblytes ; by iEtius, visus debilis ; by Boerhaave, visus hebetudo j and by some French writers, vuc confuse, faiblesse de la vuc, and mauvaise vue is not to be understood the same complaint which is described in this Dissertation, under the name of weakness of sight, but rather an indistinctness of vision, or absolute and complete ambliopy.f This ocular complaint, properly called Dulness of sight, I must briefly * The following' formula is given for this tincture. R. ofiiipurificati, croci nnglica. aa 5ij. sjnr. gallic, alb. sj aqua distillates $vij. macera in-*vas? claiiso per sex dies, deinde tincluram cola.
The1 patient being placed in a supine posture, with the head somewhat elevated, and the eyelids gently closed, a little of this tincture should be poured into the inner canthus of the eye,from whence it should be suffered gradually to insinuate itself between the palpebrae, by inclining the head to that side, and. at the same time twinkling the eye-lids ; avoiding, in the interim, most carefully, every rude effort forcibly to separate them. It may be applied by means of a camel hair pencil, in the following manner The operator, with the fingers of one hand, must cautiously depress the lower eye-lid, by which it will be somewhat averted (inverted), when the pencil, fully charged with the tincture and held in the other hand, is to be rapidly and dextrously swept across its inside, permitting the eye-lid instantly to resume its proper situation : p. 82. It seems an object to accurately diffuse the tincture over the whole anterior surface of the globe of the eye, and in particular to bring it in contact with the whole of the cornea. A rude application of this tincture, by forcibly pulling open the eye-Hds, and dropping it upon the centre of the cornea, increases the pain, and adds to the irritation.
-f-Atnbliopia est visus debilitas sine admodutn visibili ocilli vitio. Myopes et presbytes in certa objecti distanoii solumuiodo confuse vident: nyctalopcset henieralopes certo diei tempore tantilm male vident, at ambliopes in quavis distance et quo vis diei tempore objecta clejjilitcr discemunt. Flenck Docsriua de Morbis Oeuloruui, p. 186'. * Stevetison on a Disease of the Et/e. 73 n?t,ce* because I have known it confounded with weakness of sight, although it is.in fact the very reverse; and depends not upon an excess, U^ri Pos'^'ve want, of sensibility of the retina. lne principal symptoms are, not only frequent alterations in regard to' ? piecise limits, but also a great indistinctness and confusion of vision;' undei all circumstances of time and place. If the eyes be much exerted, ey soon become fatigued, which renders it necessary, every now and en, to close and gently rub them, when the patient can again see ^mewhat better for a short time. The eyes appear dull and inanimate. e iris, which is more or less dilated, is susceptible of very feeble, o tentimes scarcely any motion, even on-.'Jie sudden impulse of a strong !g t, which occasions very little uneasiness. This malady is most apt o attack persons who are past their meridian ; and is generally brought ?n y the too free use, or rather abuse, of the organ of vision, co-opera !ng with other causes which have a tendency to debilitate the gerifcral an nervous system. The disease not unfrequently remains almost stalonary.ior a great length of time. In other instances its progress is mUC TPf.6 raP^> when it generally terminates in complete gutta serena, or total blindness.

b
Various and extremely contradictory remedies have been recommended y oculists for the cure of this very formidable complaint; which, however, I shall forbear at this time enumerating. The first thing to be attended to is, to allow the eye as much rest as possible, and to avoid particulaily what may be considered the exciting causes of the disease, t is, I believe, in many cases absolutely incurable : and the only reme-ieI j . \ ^ave ever, known to prove beneficial, are topical stimulants, as electricity, galvanism, zther, infusion of capsicum, rubefacients app ie to the palpebral, &c. whereas, in genuine weakness of sight, these means are certainly useless, some of them highly hazardous, Internally^ too, meicuiials given so as slightly to affect the mouth, together with e ainica montana, and deobstruent medicines, have sometimes been productive of benefit. Double convex glasses, by concentrating the rays of light, never fail to afford, in this case, considerable assistance to the sight.
It is this particular species of disease to which I presume Mr. Ware aliudes in the following passage. " I cannot omit to mention," says he, (Vol. I. p. 122) " that in some instances where the eye has been particularly weak," (a term he employs in a vague and indefinite manner), ' without any perceptible cause to produce it, the application of spirituous remedies that have -been highly rectified, such as the medicine sold at R'ga> under the name of the Riga balsam, or the aether of the Lon-* I think it consonant with the present discussion to remark, that some cases which were deemed instances of gutta serena, 1 have ascertained to be'examples of actual dulness of sight, and that they derived tbe most essential assistance from the application of the electric and galvanic influence. Anil I cannot forbear to add, that a few cases of blindness, which have fallen under my .observation, and which wera likewise ascribed to a paralytic state ot the optic nerve, were altogether sympathetic affections, depending upon visceral irritation; by the removal of which the patient has obtained a complete cure. Of the latter description are the successful instances of amaurosis, related by Iliehter, Schmucker, and Scarpa. ' don pharmacopoeia, either alone or mixed with an equal proportion of sugar and water, has sometimes been greatly useful. In a few instances also, the excitement ot a violent inilammation, by the application of other stimuli, has been found ot use to overcome the enfeebled action of different parts of the eye." Dulness of sight again differs from the Glaucoma, as there is not that deep-seated grey appearance, or shining pearl colour, observable in the latter complaint. I am well aware, and "have met with many examples of a slight species of Psorophthalmy, which, if only cursorily regarded, seems, in some respects nearly to resemble weakness of sight. Mr. Ware, indeed, appears, from the cases he has published, to have actually identified it with this complaint. I think it necessary, therefore, to dwell a little upon this topic ; and I doubt not to be able to prove, by contrasting their respective symptoms, and the different modes of cure they individually require, that they are in reality perfectly distinct ailments. The description of this affection of the ciliary glands is so accurately given by that respectable author, that 1 shall take the liberty of transcribing the particulars, and of subjoining a few remarks in support of my opinion. " The psorophthalmy," says Mr. Ware. (Chirurgical Observations relative to the Eye, Vol I. p. 116), " not unfrequently occurs, without producing the slightest appearance of inflammation, either in the eye or eye-lid. I have attended a very considerable number of such cases ; cess attending the use of the unguentum hydrargyri nitrati, recommended for the cure of this disorder, quite as effectual as in those other instances, where the excoriation and redness of the eye-lids have been visible on the slightest inspection." There are, however, several symptoms above mentioned, which decidedly characterize that species of diseased ciliary glands, and which serve at all times to distinguish it from the subject of this Dissertation. I allude to the uncomfortable sense of weight in the lids on the approach of night, the tendency of the tarsi to adhere together during sleep, and the involuntary disposition to shut them without being drowsy, and without any particular stimulus being applied to give them pain.
In the complaint in question, on the contrary, the meibomian glands perform their functions in the most perfect manner, consequently there is not any sense of weight of the palpebral towards the close of day, inducing a propensity to shut them independently of drowsiness or uneasiness, nor is there any adhesion of their edges during the night. Hence, the application of mercurials to the tarsi, which arc almost specific in the psorophthalmy Sleveuson on a Disease of the Ei/e. 75 f-orophthalmy are absolutely useless, often prejudicial in genuine weakness of sight. Besides which, the acute pain excited by the admission of a vivid light to the eyes in cases of the latter disease, furnishes a striking discriminating feature, sufficient to point out a decided difference between weakness of sight, and the above described slight species of psorophthalmy. The injuries done to (he delicate structure of the organ of vision by the improper treatment of many of its complaints, especially those of the minor class, by their falling to the carc ot empirics, and nostrum-mongers, or even under gentlemen regularly instructed, and sufficiently qualified in the general duties ot the profession, are very numerous. These often arising from-topical applications, we cannot doubt (he propriety of giving a general currency to Mr. Stevenson's observations on the subject.
Slevenson on a Disease of the Ei/e, '7 effectual collyrium is formed of one drop of the sulphuric acid, and an ounce of distilled water, to which may be added a few grains of^ Zincum viniolatum, and a small quantity of brandy. Nor, 19 a solution o the argentum nitratum, in the proportion of from half to a whole grain to one ounce of distilled water, and half, or a whole drop of the nitrous acid", a contemptible tonic collyrium in this case. Even cold spring water is a remedy, by no means destitute of efficacy in this stage of the complaint.
The above eye waters, being intended to act as corroborants, should of course, be applied cold, three or four times a day.
As Mr. Stevenson's treatise is more of a practical than a speculative nature, and contains some novel methods of managing-a disease which seems to have l>een much misunderstood, we do not hesitate to recommend it to our readers. When our Analysis was going to press, we received the following Letter:?
Gentlemen-, ' I take the liberty of requesting a place in your very respectable Journal, for the following observations upon a publication of Mr. Stevenson's, Ujjon the di. ease called weak sight-My sole wish, in communicating these rem;;:ks, i *.o do justice to a most respectable member of the profession, whom 1 have long known, and also to set some other matters upon their proper footing. In attempting to effect these object* I should be sorry to shew any disrespect towards Mr. Stevenson.??
The first obseivation which I shall make upon the dissertation, is, diat from the language used in page 5 of the preface, the reader might > conclude that the knowledge of the proximate cause of the disease in question, as well as the filan of cure, originated with Mr. S.?" I was," says he,"repeatedly disappointed in any attempts to relieve it, before adifferent view of the proximate cause, and a corresponding variation in the mode of cure suggested themselvesThis view of the proximate cause is described by Mr. S. in the following words : " And with regard to the proxi-?njate cause of weakness of sight, instead of local debility, I will hazard, the ofiinion, that it consists in an exquisite irritability and sensibility of the retina, the effect of a great turgescency of the vessels, or a chronic inflammation of that membrane, or the choroid." Mr. S. however, in the next sentence, quotes this opinion from Sauvages: " Intolerantia lucis retinae sensibilitatem adauctam esse probat, sive detur ejus infarctus pblogisticus, sive tensa sit nimiuro choroidea, ejusque expansio uvea." This quotation from Sauvages, appears to me to convey nearly the same opinion as that suggested by Mr. S. But leaving the reader to judge for himself, I shall proceed to say a few words upon the corresponding variation in the mode of trer.iment, which suggested itself to Mr. S. at the same time. In this point, also, or at least, in the chief part ot it, Mi . S. it would appear, had been long anticipated by Mr. Ware. 1 o make this clear I need only refer the reader to the cases quoted at length from Mr. Ware's observations. From these cases (which extend from page 51 to 58, inclusive, of Mr. S.'s work) it is evident, that evacuation ly means of leeches was used by Mr. Ware, when the plan which he usually adopted, proved ineffectual.? Independent, ho\veyer, of these considerations, the general plan recommended by Mr. S. is 75 Critical Analysis. is by no means new. I am acquainted with many eminent practitioners in different quarters of the kingdom, who occasionally resort to leeches, but uniformly employ the other parts of the evacuant plan, such as purging with calomel, blisters, setons, &c. They have also used remedies to promote a determination to and discharge of blood from the nose, of whieh Mr. S. makes no mention. To those surgeons, however, who were ignorant of the evacuant plan, Mr. S.'s statement of the fact will be acceptable. Valeat quantum valere potest.?Having now done justice to the celebrated Sauvages and Mr. Ware, I shall next say a few words respecting the validity of the proximate cause. Mr. S. has, however, stated it in terms so different in different pages of his work, that it will be necessary to collect the whole into one point of view.
After describing this cause in the words already mentioned, (page 11) Mr. S. next remarks, (page 12) " that this highly nervous and vascular tunic (the retina) is either in an actually inflamed, or, at least, in a morbidly distended, and, consequently, irritable condition." He next observes, (p '-ge 12) " that genuine weakness of sight is actually a disease in the retina arising from the great turgescency, or chronic inflammation of that membrane," &c. Next (page 33) " the exquisite sensibility of the eye might with more probability be the result of 2 chronic inflammation, or, at least, highly turgid condition of the blood-vessels of the retina or choroid." Next (at page 60) " The proximate cause of weakness of sight is a turgescency or more or less inflammatory affection of the fwsterior vascular membranes of the eye." Soon afterwards (page 62) i| this expression, " Do not the history of the above case and its dissection demonstrably prove, that -weakness of sight does not, always at least, proceed from a nervous affection of the retina, but that it is the actual result of a greater or less degree of inflammation of the choroid V* Lastly, our author observes, (page 29) ?.* In these cases (of psorophthalmy) the inflammation seems continuous, extending itself from the margin of the taisi along the palfebraic to the corneal conjunctiva. Even in this instance, however, I conceive that the intolerance of light does not arise, at least only sympathetically, from an affection of the retma, but rather from the cornea itself, which" &c. &c.?From the* quotations it appears, that Mr. S.'s opinion respecting the proximate cause is somewhat fluctuating. For my own part, I think it questionable and inconsistent with fact6, but to attack it under all its protean forms would be a fruitless task, or almost impossible; for I confess myself ignorant of Mr. S.'s meaning when he talks of the distended condition of the turgescency, or or the nervous affection of the retina, or of the posterior vascular membranes of the eye. Still less can I comprehend how " light really acts in expanding the vessels of the retina (page lb.) That blood may expand, or distend these vessels, is obvious : but we have yet to learn what expansive powers are exerted upon biood-ve*sels by light, even from the meridian sun, which as our author informs us (page 15) destroyed the Roman general Regulus. I shall therefore conline myself to Mr. S.'s lirst opinion.
The first observation, which 1 shall make, is, that Mr. S. in defining his proximate cause, supposes that exquisite irritability and sensibility of the retina, is the effect either of chiomc inflammation of the retina, or of the cliToid indifferently. Why chronic inflamation of the choroid should producc Stexenson on a Disease of the Eye. ? ? '9 produce the same symptoms, as a similar affection of the retina, since the two membranes are totally different in their structuie ;ind uses, requires elucidation. My next observation is, that the chronic inflammation of any membrane or organ, with which I am acquainted, is with difficulty and only gradually removed. Tliis does not well accord with the astonishing and immediate efficacy of leeches and vacations. Nor does chronic inflammation ever exist long without leaving lasting marks behind it. How few anatomists, however, have detected any obvious morbid change in the retina or choroid.
But admitting that chronic inflammation, or a great turgescency of the vesselsof the retina or chotoid coat exists, it is somewhat remarkable that these affections do never spread to the iris. The blood-ve^cis of the iris are most intimately connected with those of the choroid, yet the latter may labour under great tui gescency, without producing any perceptible change in the former. The same observation may be made with respect to one part of the vessels of the sclerotic coat. These are derived from the same source as the vessels of the choroid coat, nny ?ome of the vessels of the choroid itself pass directly through the sclerotic coat, and ramify upon it externally, yet, in the disease in question, no symptoms of turgescency appear in these vessels, however close their connection. For these reasons I consider Mr. S's opinion highly questionable : and if I may be allowed to advance another, 1 would say, that weakness of sight is, probably, produced in this manner. In the fiist place, the exciting causes, such as excessive light, intense reading, &c. being frequently applied, the sensibility of the retina is increased, which induces some degree of increased action in its blood-vessels, and those of the choroid also, by sympathy. This state would, in most cases gradually subside, were the exciting causes withdrawn. From the repeated application, however, of these causes, a morbid action at length arises in the secretory vessels of the choroid. 1 hi , so far alters the quality or quantity of the secretion of pigmentum nigrum, as to render *it unfit for its purpose of absorbing erratic or reflected light within the eye.
In short, I conceive, that the state of the eyeball in this disease, bears a striking analogy to that defective state, which obtains in albinos.
Such astate, I apprehend, perfectly coincide^ with the effect of the evacuant mode of treatment, ai:d is liable to no material objection.
The effect of the first application of leeches is probably that of allaying the irritability of the retina : this topical evacuation, with the use of sedative applications, and the removal of all exciting causes is principally instrumental in suspending this most distressing symptom of the disease, and at the same time lays the foundation of that healthy change in the action of the secretory vessels of the choroid, which is Anally completed by the use of purgatives. The morbid action in the secretory vessels of the choroid, in this instance, is, prubabiy,not inflammatory, but rather bears an analogy to that change, which oc^asionnlly occurs in the action of the vessels of other secretory organs, producing an alteration in the nature of their secretions, without being accompanied by any symptom of turgescency or inflammatory disposition. The effects of purging and other evacuations, in re-establishing their healthy functions, is well known. This view of the proximate c.uise explains also, why tonics, conjoined with sedative applications, and freedom from all exciting 50 ' Critical Analysis. exciting causes, are, in particular habits, effectual in removing'this disease ; particularly if conjoined with alterative doses of calomel. I shall not dwell longer upon this subject, as 1 am, by no means, very solicitous about the adoption of this or that opinion respecting the proximate cause of weak sight. What is of much greater importance, is, that Mr. S. setting aside all selfish motives of concealment, has candidly made known to the profession at large his experience in me;;n?, which few practitioners have employed more extensively or successfully, than himself ; and that he has, moreover, announced some important improvements in the treatment of Blear-eye> which, after repeated trials, he at length discovered (See note, page 28). That the public may lose no part of the advantage to result from this discovery, I dare say, that the Editors of the Medical and Physical Journal will be happy to place it without loss of time amongst their excellent pages. I am confident that Mr. S. will pa. don any liberty I may have taken, in making these remarks upon his publication. To do justice to all parties has been my sole aim, and 1 know that no member of the profession would with more pleasure " reuder unto Ca>sar the things which are We should not have thought it necessary to notice a third edition of this valuable work, had it not been lor the illustrations of one who has so lone; been considered the interpreter of his favourite master. To pursue the plan we have hitherto adopted, we shall content ourselves with offering a few extracts as a specimen of the work, instead of the often unthankful task ot minutely criticising individual passages.
The following is Dr. Adams's commentary on that part of Mr. Hunter's introduction which relates to hectic fever.